Preliminary results from a randomized trial of an intervention designed to increase the patient's role in medical care among diabetic patients have shown encouraging trends in impact on specific health outcome measures, e.g., blood glucose control. Effects on patients' physical, social and role related limitations due to illness that have shown improvement in our previous work among patients with ulcer disease are being studied among diabetics. We have also developed and tested a multi-construct measure of patient orientation toward health care that is being used to predict response to the intervention. The positive results of this work have led us to propose expansions intended to amplify the effects observed to date. We now propose to develop and test an intervention aimed at doctors, training them to assist patients in assuming greater responsibility for important medical management decisions. We anticipate that intervening with both doctors and patients will produce greater effects than with patients alone. The effects of both interventions on specific physiologic, behavioral and attitudinal health outcomes will be tested in a randomized controlled trial. A subsample of patients will be followed over an 18 month period to explore long term intervention effects. We propose to develop modifications in our patient intervention tailoring it to the needs of those patients with a very passive orientation to care. These patients will be identified prior to administration of the intervention, using our previously validated attitudinal measures. Finally, we propose to test the feasibility of implementing the intervention in a non-academic clinic setting. If successful, this research will provide a feasible way to increase patients' involvement in medical care that leads to improved health outcomes.